outbreak in the Democratic Republic of the Congo has not yet risen to the level of a Public Health Emergency of International Concern, or PHEIC, experts declared today.
Officials remain worried about the deadly virus’ spread into an urban area nearly 100 miles from the epicenter of the outbreak, but
Robert Steffen, MD, chairman of an emergency committee convened by WHO to evaluate the public health threat beyond the Democratic Republic of the Congo (DRC), said “conditions ... have not been met” to declare a PHEIC.
However, Steffen said, “If the outbreak expands significantly or if there is international spread, the emergency committee will reconvene and reconsider its fundamental decision.”
He said nine neighboring African countries have been warned that they are at high risk for Ebola spreading across their borders, especially the DRC and the Central African Republic.
Experts said the Ebola outbreak in the Democratic Republic of the Congo has not reached the level of a public health emergency of international concern.
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In a press conference in Geneva, WHO Director General Tedros Adhanom Ghebreyesus, PhD, MSc, said immunizations with Merck’s experimental Ebola vaccine will begin on Sunday. The agency previously said that the vaccine, V920, would be given on a voluntary basis to health care workers and anyone else who has had contact with patients with a confirmed case of Ebola or their contacts.
It is the first time an Ebola vaccine will be used to help stop an outbreak. Because the vaccine remains unlicensed, vaccinations will be given as part of a trial, with participants followed for an unspecified period of time. In a similar trial conducted during the height of the Ebola epidemic in West Africa, the vaccine was shown to be highly protective against the Zaire strain of the virus, which WHO has confirmed is causing the current outbreak.
The DRC declared an Ebola outbreak on May 8. Since April 4, there have been 45 reported cases and 25 deaths associated with the outbreak. Of these, 14 have been confirmed as Ebola infections, including one death. There have been 21 probable and 10 suspected cases.
Officials this week expressed concern over Ebola cases appearing in Wangata, an area near the large Congo River port city of Mbandaka, where more than 1 million people live. Four cases — including one confirmed infection — and one death have been reported in the area.
Peter Salama, MBBS, MPH, WHO deputy director-general for emergency preparedness, called the confirmation of Ebola in the area “a game changer” and said “the challenge just got much, much tougher.”
The outbreak is centered in the hard-to-reach town of Bikoro, in the northwestern province of Équateur, but has spread to three other areas, including Wangata. It is the ninth Ebola outbreak in the DRC since the virus was discovered in the country in 1976.
According to Tedros, there is a mobile laboratory on the ground in Bikoro, and 11 cases have been isolated at a hospital in the town that was visited by the director-general this week. Tedros said around 530 contacts of patients have already been identified and will need to be vaccinated.
“We are really encouraged by what we have seen on the ground,” he said.
The remoteness of Bikoro, which has few paved roads, has made the response in the outbreak’s epicenter challenging, Tedros said. He traveled to the area by helicopter this week, and the United Nations had to airlift supplies and personnel on the ground. Tedros said WHO has already secured $8.8 million of funding out of a requested $26 million.
The director-general convened an emergency committee under the International Health Regulations to decide if the outbreak warranted the declaration of a PHEIC. According to WHO, declaring a PHEIC “implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected state’s national border; and may require immediate international action.” The PHEIC for the West African Ebola epidemic lasted from August 2014 to March 2016. Over 28,000 people were infected and more than 11,300 died in that epidemic, most of them in the three West African countries of Guinea, Liberia and Sierra Leone.
Steffen chaired the 11-member committee, which met by teleconference. The meeting included presentations by representatives from the DRC on recent developments in the outbreak and the steps that have been made to contain it.
The committee noted several challenges, including that the outbreak had reached an urban area along a major river that connects to several other countries with porous borders, which could facilitate rapid spread, and the remoteness of the other affected areas. But it said the response has been “rapid and comprehensive” and that there was “strong reason” to believe the outbreak could be controlled.
WHO has advised against placing any restrictions on travel or trade in the region. – by Gerard Gallagher
Disclosures: Salama, Steffen and Tedros report no relevant financial disclosures.